Interprosthetic Femur Fractures: A Multicenter Retrospective Study

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Abstract
OBJECTIVES: To identify practices for treating interprosthetic femur fractures (IFFs) and determine factors that positively affect patient outcomes. METHODS: . Design: Retrospective cohort study. Setting: Fifteen trauma centers in the United States. Patient Selection Criteria: Patients aged 50–90 years who underwent operative fixation of an AO/OTA 32 A-B-C type IFF fracture from 2011 to 2021 were included. Patients who underwent revision arthroplasty at the time of fixation or were nonambulatory were excluded. Outcome Measures and Comparisons: The primary outcome was union rate. Secondary outcomes included postoperative complications, revision surgery, mortality, and change in ambulation status. Univariate analyses using chi-square tests, Fisher exact tests, and analysis of variance were performed to detect associations between demographic, injury, and surgical characteristics with postoperative outcomes. RESULTS: One hundred thirty-nine patients were included, with 110 (79%) women and median age 78 [range, 57–90]. Distal one-third fractures were most common, 68% (N = 95). One hundred eighteen (85%) patients were treated with a lateral plate, 8% (N = 11) were treated with nail–plate combination and 7% (N = 10) were treated with dual plates. The median time to full-weight bearing was 2.5 months. Dual plate combination was associated with the fastest time to full-weight bearing (P = 0.048) at 2 weeks. In total, 61% (n = 85) of patients returned to baseline ambulation status (100% [11] IMN–plate, 60% [71] lateral plate, and 25% [3] dual plate) with patients treated with nail–plate had higher rates of return to baseline function (P = 0.009). The overall mortality rate was 13% and associated with greater than 1 comorbidity (P = 0.022). CONCLUSIONS: A spanning lateral plate was the most common fixation of IFF. Patients with dual fixation were more likely to return to baseline ambulatory status, particularly those with intramedullary nail–plate combination. The mortality rate at 1 year was 11% and comorbidity burden was associated with higher risk of mortality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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